Coach, Counselor, Therapist, or Psychologist? The Differences
Getting help is a lot easier said than done if you don’t know what you need. Here’s a beginner’s guide.
It’s now common knowledge that COVID-19 was not only a health crisis but a mental health one. Rates of depression, anxiety, suicide, and help-seeking all increased amidst lockdowns and quarantines, as pandemic safety measures removed our usual social and physical distractions and increased our sense of isolation.
But the seeking of mental health help (through in-person sessions or telehealth) was not equal among all demographic groups. In the US, BIPOC did not see rates of increase that matched white Americans; Women continue to seek and receive mental health treatment at higher rates than men.
This is all relatively hidden information that is not apparent from the recent explosion of my favorite stuff on the Internet — therapy memes.
I’ve been on both proverbial sides of the therapy couch, and I love these.
The recent destigmatization of therapy is a welcome boost to treatment access, but stigma is not the only barrier. Cost, availability, insurance, quality, and just knowing what kind of help you may need are other impediments.
Let’s start with just understanding the roles of the various professionals in this field. (Covering the different forms of therapy will be available soon in a separate story.)
Coaches
Coaches exist for every coachable topic under the sun, including for mental health and abuse recovery. Coaching is an unregulated industry; MLMs (multi-level marketing companies) and coaching schools sell certification programs and offer trainings but these, as explained here, may not guarantee coaching clients or even good results.
To flip it for the end user: there are certification programs but ultimately no barriers for anyone to call themselves a coach. Coaching fees are also all over the map (from a two-figures up to 4-figures a session or month), very much determined by what a coach feels they are worth.
While there are independent and affordable coaches who’ve developed good programs on target topics, one caveat to coaching in general is that this is a “buyer beware” market. It’s not unusual for coaches to sell coaching programs teaching others to sell coaching programs, a problematic practice deservedly receiving more scrutiny from anti-MLM quarters of the Internet. (I cover this in the story at the box link below.)
Points to consider
Coaches sell programs, some talented ones using their own material, others borrowing their material from someone else. Most of these programs may assume their target is neurotypical and not facing bigger challenges, and work on best-case scenarios for both learning and implementation. Customized or one-on-one sessions may be offered as “opt-ins”.
A coach’s marketing content that I saw described counseling as “talking about the past” while coaching was “working on the future”. Besides being reductionistic (and untrue), it glosses over the reality that many people operate out of what they learned from the past, and many of these mechanisms may still serve present needs.
It takes sensitivity and time to unpack these without blame and in a way a coach may not be trained to do compassionately. The coach may also lack broad-based training that would allow them to recognize different mental health needs in their clients.
This said, I’ve seen counseling and therapy techniques sold as coaching in environments that may harbor stigmas against people who seek mental health services. A closer look at someone’s qualifications will clear this up.
Counselors
Despite their name, counselors aren’t supposed to be providing advice — they’re trained to offer an empathetic ear, occasionally to use approaches that inspire different perspectives and help their clients formulate next steps. Most counselors are also familiar with coaching techniques such as Motivational Interviewing.
Done right, counseling is a safe space for clients to feel heard and be able to get objective feedback with their best interests in mind. Clients are encouraged to have their counseling goals, and counselors provide feedback, education, and unconditional positive regard. The last element is crucial in what is known as person-centred therapy.
There can be a lot of overlap between counselor and therapist, and it may come down to what modalities and training a counselor or therapist has in their tool belt.
So let’s talk about that next.
Therapists
As a general rule, qualifications are higher (usually a Master’s) for practicing psychotherapy than for counseling. They are generally required to know their way around the DSM (Diagnostic and Statistical Manual of Mental Disorders) and spot symptoms of common disorders without making diagnoses.
Therapists are also trained in one or more therapy approaches, to formulate treatment plans, and to be able to identify issues that need more urgent attention and intervention. They should have, for every issue presented by their client, multiple hypotheses and possible approaches for addressing those issues.
This said, therapists can and frequently do have different preferred approaches and solutions, and this is where different “T”s pop in, from CBT (Cognitive Behavioral Therapy) and SFBT (Solution-Focused Brief Therapy) to DBT (Dialectical Behavioral Therapy) and CTRT (Choice Theory & Reality Therapy).
And then there are also treatment approaches that have different letters from IFS (Internal Family Systems) to TA (Transactional Analysis) and EMDR (Eye Movement Desensitization and Reprocessing).
For potential clients, these initials and acronyms may seem like a lot to navigate, but the truth is, it’s the therapist who should be familiar — and honest — with the strengths and limitations of each therapeutic approach. For best results, a therapist can fit and adapt their tools and skillset to a client’s needs or should be upfront when they can’t.
Points to Consider
Counselors and therapists both share broad-based, foundational training in counseling and mental health to get their qualifications. This is required before they may choose to specialize in an area of counseling, such as relationship or family counseling, group or addiction counseling, counseling youth and/or children, or dealing with grief, childhood trauma, or eating disorders.
Individual counselors and therapists may vary, but all should have a toolbox of different evidence-based mental health approaches. Counselors and therapists are trained to know better and not be limited to motivational quotes and toxic positivity.*
(*This said, anecdotes from counseling and therapy clients do reveal it’s possible to still run into counselors/therapists who fumble with victims of religious, childhood, or s*xual abuse; LGBTQ+ or neurodivergent clients, or clients from a different cultural or racial background. Not all counselors or therapists are equal; some may be limited in their experience, or cultural or religious outlook.)
Psychologists
Of the titles covered so far, psychologists and clinical psychologists need the most training (a Master’s at minimum) and specific qualifications that gives them the — drumroll, please — power to diagnose the disorders listed in the DSM.
This possibly puts psychologists as the more desired, qualified, and expensive mental health professional to see, but they may also be harder to get an appointment with.
On the upside, most people with “garden-variety” depression and anxiety may not need to see a psychologist unless sessions with a therapist are inadequate or the client really needs a diagnosis. This said, psychologists cannot prescribe medication, but psychiatrists can. (Psychiatrists all need a Doctorate to practice.)
In educational or institutional settings, it’s not unusual for some clients to have both a psychologist and a counselor or therapist. The counselor or therapist may provide more frequent sessions and regular check-ins while the psychologist may be overseeing the larger treatment plan and progress.
Last Notes
I wanted to write this article as I was once an absolute newbie and even had a coach or two before getting myself counseling and EMDR, and now a Master’s in Counseling and learning different therapy approaches. I also came from a family that looked upon Psychology and Psychiatry with suspicion and skepticism, and that was also steeped in the cultural conditioning that professional help was for the mentally weak. Not so.
I hope this article is useful — -if you have any questions for me, just holler in the comments! Stay subscribed to be notified when I publish the article on the different therapies out there.
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